Healthcare Provider Details

I. General information

NPI: 1114336153
Provider Name (Legal Business Name): MEGGAN LEIGH REISCH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGGAN LEIGH JOHNSON CNP

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S MAIN ST
HOWARD SD
57349-9064
US

IV. Provider business mailing address

728 S WASHINGTON AVE
MADISON SD
57042-3509
US

V. Phone/Fax

Practice location:
  • Phone: 888-212-1627
  • Fax:
Mailing address:
  • Phone: 605-556-1004
  • Fax: 217-771-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR037821
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP000920
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: